In other news from the conference, researchers took a deeper look at the Memory and Aging Project data to sort out diet patterns associated with better brain aging after a stroke. The investigators found that, as for preservation of cognitive performance over time in the overall population, a diet that blends the low-sodium, high-vegetable, lean-protein, and olive oil aspects of the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets, along with an emphasis on green leafy vegetables and berries, appeared to benefit stroke survivors.

People in the top third for adherence to a so-called MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet had a significantly slower rate of global cognitive decline on a periodically repeated battery of tests than those whose diet was farthest from it, with an almost as good an effect for the intermediate group.

However, presenter Laurel Cherian, MD, of Rush University Medical Center in Chicago, cautioned that the study could not determine causation and that “a dietary intervention trial would be necessary to validate the role of the diet in long-term outcomes for stroke survivors.”

Low-Dose New Oral Anticoagulants for Stroke Prevention

Further analysis of the COMPASS trial, which showed that an ultra-low dose of rivaroxaban (Xarelto) improved cardiovascular outcomes in stable atherosclerotic vascular disease when added to aspirin, at the stroke meeting dove into stroke prevention with the combination.

As reported previously in the main paper, there was a reduction in ischemic stroke with the rivaroxaban-aspirin combination but a numerical increase in hemorrhagic stroke compared with aspirin alone. In the subanalysis, both patients with prior stroke and those without had a significant benefit in second stroke prevention, but the magnitude was significantly greater with a prior stroke.

The absolute reduction in annual stroke rate was 2.7% among patients with previous stroke, with a number needed to treat of 37, which the lead researcher said makes it “very attractive” for secondary prevention.

Thrombectomy versus Brain Edema

Mechanical thrombectomy was associated with less brain edema in a secondary analysis of the MR CLEAN trial reported at the Stroke meeting and in JAMA Neurology.

Mid-line shift in follow-up imaging was significantly less likely with substantial reperfusion with a modified treatment in cerebral infarction score of 2b or 3 and with a modified arterial occlusive lesion score of 3. But when this edema was seen, it was associated with worse functional outcome at 90 days (20% odds per mm increase).

“Our study reinforces the benefits of early reperfusion and recanalization in reducing brain edema and suggests that endovascular therapy does not increase the extension of brain edema, as has been reported in preclinical models,” the researchers wrote. “These data also suggest that edema may help explain the previous observation that final infarct volume only partially accounts for the endovascular therapy effect on outcome.”